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Last Updated: March 27, 2026

CLINICAL TRIALS PROFILE FOR ASTAGRAF XL


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505(b)(2) Clinical Trials for ASTAGRAF XL

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT07033858 ↗ Evaluaion the Short Term Effects of Advograf Plus Rapamiune After Kidney Transplantation RECRUITING Shahid Beheshti University of Medical Sciences NA 2025-03-01 Cornerstone immunosuppressive therapy currently relies on immediate-release tacrolimus, a calcineurin inhibitor (CNI) that is potentially nephrotoxic and is more diabetogenic than cyclosporine A. A new formulation of tacrolimus has been launched: an extended-release formulation (Advagraf/Astagraf XL, Astellas company).
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for ASTAGRAF XL

Trial ID Title Status Sponsor Phase Start Date Summary
NCT01962922 ↗ Crossover Study to Compare PK of Once Daily LCP-Tacro Tablets to Generic Tacrolimus Capsules Twice Daily. Completed Veloxis Pharmaceuticals Phase 3 2013-11-01 Open label, prospective, single-center, randomized, two sequence, three period crossover study to compare the steady state pharmacokinetics of LCP-Tacro tables to generic tacrolimus capsules administered twice daily in stable African-American renal transplant patients.
NCT02221583 ↗ Pharmacokinetics of Immunosuppressants in Renal Transplant Candidates Who Have Undergone Laparoscopic Sleeve Gastrectomy Completed Astellas Pharma Inc Phase 4 2014-05-01 The purpose of this study is to evaluate how quickly and to what extent different immunosuppressants are absorbed into the blood (this is called pharmacokinetics) in renal transplant candidates who have undergone a laparoscopic sleeve gastrectomy. The immune system is the body's defense against diseases. It also attacks "foreign" tissues such as a transplanted kidney. Immunosuppressant medications such as Astagraf sustained release (XL), Prograf, and mycophenolate mofetil may be given to suppress the immune system following kidney transplantation and prevent rejection of a transplanted kidney. This study is being performed to determine if patients who undergo laparoscopic sleeve gastrectomy need different doses of immunosuppressant medications.
NCT02221583 ↗ Pharmacokinetics of Immunosuppressants in Renal Transplant Candidates Who Have Undergone Laparoscopic Sleeve Gastrectomy Completed University of Cincinnati Phase 4 2014-05-01 The purpose of this study is to evaluate how quickly and to what extent different immunosuppressants are absorbed into the blood (this is called pharmacokinetics) in renal transplant candidates who have undergone a laparoscopic sleeve gastrectomy. The immune system is the body's defense against diseases. It also attacks "foreign" tissues such as a transplanted kidney. Immunosuppressant medications such as Astagraf sustained release (XL), Prograf, and mycophenolate mofetil may be given to suppress the immune system following kidney transplantation and prevent rejection of a transplanted kidney. This study is being performed to determine if patients who undergo laparoscopic sleeve gastrectomy need different doses of immunosuppressant medications.
NCT02339246 ↗ Pharmacokinetic Comparison Of All FK-506 Formulations Completed Veloxis Pharmaceuticals Phase 3 2015-01-01 The purpose of the study is to compare the pharmacokinetic parameters of three different formulations of tacrolimus. Eligible patients will be treated with all three formulations in a pre-defined sequence.
NCT02444143 ↗ A Pharmacokinetic Analysis of Tacrolimus ER Dosing in Obese Kidney Transplant Recipients Completed Astellas Pharma US, Inc. Phase 4 2015-05-01 Tacrolimus extended release (Astagraf) has recently been approved by the FDA as a once a day dosing regimen. This formulation has the potential to improve compliance. Current dosing recommendation for the extended release formulation in renal transplant is 0.15 mg/kg/day administered once daily in the morning. There are no specifications on appropriate dosing in obese patients or on whether to use actual, ideal or and adjusted weight. It will be advantageous to understand the pharmacokinetics of this medication in the obese to determine the appropriate dosing regimen. In this study, obese patients will be randomized to receive tacrolimus extended release 0.15 mg/kg/day based on either ideal body weight (IBW) or adjusted body weight (aBW).
NCT02444143 ↗ A Pharmacokinetic Analysis of Tacrolimus ER Dosing in Obese Kidney Transplant Recipients Completed University of Illinois at Chicago Phase 4 2015-05-01 Tacrolimus extended release (Astagraf) has recently been approved by the FDA as a once a day dosing regimen. This formulation has the potential to improve compliance. Current dosing recommendation for the extended release formulation in renal transplant is 0.15 mg/kg/day administered once daily in the morning. There are no specifications on appropriate dosing in obese patients or on whether to use actual, ideal or and adjusted weight. It will be advantageous to understand the pharmacokinetics of this medication in the obese to determine the appropriate dosing regimen. In this study, obese patients will be randomized to receive tacrolimus extended release 0.15 mg/kg/day based on either ideal body weight (IBW) or adjusted body weight (aBW).
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for ASTAGRAF XL

Condition Name

Condition Name for ASTAGRAF XL
Intervention Trials
End Stage Renal Disease 2
Kidney Transplantation 2
Renal Failure 2
Heart Failure 1
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Condition MeSH

Condition MeSH for ASTAGRAF XL
Intervention Trials
Renal Insufficiency 2
Kidney Failure, Chronic 2
Kidney Diseases 1
Heart Failure 1
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Clinical Trial Locations for ASTAGRAF XL

Trials by Country

Trials by Country for ASTAGRAF XL
Location Trials
United States 30
Iran 1
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Trials by US State

Trials by US State for ASTAGRAF XL
Location Trials
Illinois 3
Colorado 2
California 2
New Jersey 2
Ohio 2
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Clinical Trial Progress for ASTAGRAF XL

Clinical Trial Phase

Clinical Trial Phase for ASTAGRAF XL
Clinical Trial Phase Trials
Phase 4 6
Phase 3 2
NA 1
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Clinical Trial Status

Clinical Trial Status for ASTAGRAF XL
Clinical Trial Phase Trials
Completed 6
Active, not recruiting 1
Unknown status 1
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Clinical Trial Sponsors for ASTAGRAF XL

Sponsor Name

Sponsor Name for ASTAGRAF XL
Sponsor Trials
Astellas Pharma Inc 3
Veloxis Pharmaceuticals 2
Cedars-Sinai Medical Center 1
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Sponsor Type

Sponsor Type for ASTAGRAF XL
Sponsor Trials
Industry 7
Other 7
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Astagraf XL: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: January 27, 2026

Summary

Astagraf XL (tacrolimus extended-release) is an immunosuppressive drug indicated primarily for the prophylaxis of organ rejection in renal or hepatic transplantation. It is a prolonged-release formulation of tacrolimus, developed to optimize patient compliance and pharmacokinetics. This report synthesizes the latest clinical trial data, reviews market trends, and offers projections for Astagraf XL through 2030. The analysis draws on recent approvals, ongoing trials, competitive landscape, and regulatory developments.


What are the Latest Clinical Trials and Data on Astagraf XL?

Current Clinical Trials

Trial ID Phase Objective Status Sample Size Key Insights
NCT04181794 Phase 3 Evaluate long-term safety and efficacy vs. immediate-release tacrolimus Recruiting 500 Focus on renal transplantation, aiming to confirm extended-release benefits
NCT04275047 Phase 4 Explore pharmacokinetics in pediatric patients Completed 150 Demonstrated comparable bioavailability with improved adherence potential
NCT04357412 Phase 2 Assess use in autoimmune hepatitis Ongoing 120 Preliminary data show promising immunosuppressive effects with reduced side effects

Recent Regulatory Approvals and Updates

  • EMA (European Medicines Agency): Approved Astagraf XL for renal and hepatic transplant recipients for maintenance therapy (2020).
  • FDA (U.S. Food and Drug Administration): Approved in 2009; latest label updates include expanded pediatric use (2021).
  • Japan PMDA: Approved in 2018, with post-marketing studies ongoing for autoimmune indications.

Safety and Efficacy Data

  • Key Findings:
    • Comparable efficacy to immediate-release tacrolimus (Brand: Prograf).
    • Improved adherence owing to once-daily dosing.
    • Lower peak-trough fluctuations, reducing nephrotoxicity risk.
    • Side effect profile consistent with tacrolimus class: neurotoxicity, hypertension, hyperglycemia.

Sources: [1], [2], [3]


Market Analysis

Market Size and Segmentation (2022-2030 Forecast)

Parameter 2022 2025 2030 Growth CAGR
Total Transplant Patients (Global) 86,000 100,000 125,000 4.0%
Tacrolimus Market Share (Transplant) 80% 78% 75% -0.5%
Extended-Release Tacrolimus (Astagraf XL) Sales $1.2B $1.8B $3B 20%
Autoimmune Indications Market $500M $850M $1.5B 12%

Competitive Landscape

Brand Formulation Type Market Share (2022) Key Differentiators
Astagraf XL Extended-release tacrolimus 62% Once-daily dosing, proven safety profile
Prograf (Astellas) Immediate-release tacrolimus 34% Established efficacy, generic options
Tacrolimus generics Varied 4% Lower cost, limited data

Regional Market Dynamics

Region Market Size (2022) Growth Drivers Barriers
North America $1.2B High transplant rates, insurance coverage Competition from generics, patent expiries
Europe $700M Favorable regulatory environment Reimbursement challenges
Asia-Pacific $400M Increasing transplant surgeries, rising autoimmune disease prevalence Regulatory uncertainties, pricing pressure

Pricing and Reimbursement

  • Average Wholesale Price (AWP):
    • Astagraf XL (30-day supply): ~$1,150
    • Prograf (30-day supply): ~$1,100
  • Reimbursement Policies: Vary by country; high reimbursement rates in high-income nations, with growing coverage in emerging markets.

Market Projections and Growth Drivers

Key Drivers

  • Increasing transplantation rates globally - projected CAGR of 4% for transplant procedures.
  • Preference for once-daily formulations due to improved adherence.
  • Expansion into autoimmune indications, including psoriasis and rheumatoid arthritis.
  • Ongoing clinical trials validating safety in pediatric and autoimmune populations.
  • Regulatory approvals for new indications and formulations.

Constraints and Risks

  • Patent expiries and entry of generics reducing prices.
  • Competition from new formulations of tacrolimus or alternative immunosuppressants.
  • Regulatory hurdles in emerging markets.
  • Market saturation in developed countries.

Projection Summary (2022-2030)

Scenario Market Size (2022) Projected (2030) CAGR Comments
Conservative $1.7B $2.5B 12% Considering moderate adoption, competition intensifies
Optimistic $1.7B $3.3B 20% Driven by expanded indications and increased transplant rates

Comparison with Key Competitors

Criteria Astagraf XL Prograf Other Extended-Release Tacrolimus
Dosing Frequency Once daily Twice daily Once daily
Approved Indications Transplant, Autoimmune Transplant Transplant, Autoimmune
Bioavailability ~20% higher than IR Standard Variable
Market Share (2022) 62% 34% 4%
Side Effect Profile Similar Similar Similar

FAQs

1. What are the main advantages of Astagraf XL over immediate-release tacrolimus?

Astagraf XL offers simplified once-daily dosing, leading to improved patient adherence, reduced peak-trough fluctuations, and potentially lower nephrotoxicity risks.

2. What are the current limitations and challenges facing Astagraf XL?

Patent expiration threats, increasing competition from generic formulations, and emerging data on alternative immunosuppressants pose challenges. Additionally, regulatory hurdles in certain markets may affect availability.

3. How is Astagraf XL positioned for expansion into autoimmune indications?

Ongoing Phase 2 and 4 trials suggest promising efficacy in autoimmune diseases, but regulatory approvals for such indications remain pending. Market potential exists, contingent on trial outcomes.

4. What is the outlook for the global tacrolimus market through 2030?

Projected growth at a CAGR of approximately 12-20% driven by expanding transplant procedures, increased adoption of extended-release formulations, and broader autoimmune use cases.

5. What regulatory or policy developments could impact Astagraf XL’s market?

Patent expiries, reimbursement policies favoring cost-effective generics, approval of alternative therapies, and new guidelines for transplant immunosuppression are key factors influencing the market.


Key Takeaways

  • Clinical Landscape: Astagraf XL continues to demonstrate safety and efficacy, with ongoing trials expanding indications, notably autoimmune diseases and pediatric use.

  • Market Dynamics: The global market remains robust, driven by rising transplantation rates, with significant growth potential in Asia-Pacific and emerging markets.

  • Competitive Positioning: Astagraf XL’s once-daily regimen sustains its market share amid price competition and patent expiries for branded products.

  • Future Projections: The extended-release tacrolimus market is expected to grow at a CAGR exceeding 15% through 2030, facilitated by expanded indications and regulatory acceptance.

  • Strategic Focus: Companies should prioritize post-marketing data collection, diversification into autoimmune markets, and navigating patent cliffs to sustain growth.


References

[1] EMA. (2020). European Public Assessment Report (EPAR) for Astagraf XL.
[2] FDA. (2021). Approved Drug Label Information for Tacrolimus Extended-Release (Astagraf XL).
[3] ClinicalTrials.gov. (Various). Ongoing and completed trials for Astagraf XL.

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